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    Summary
    EudraCT Number:2020-004490-52
    Sponsor's Protocol Code Number:MK-1308A-004
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-06-08
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2020-004490-52
    A.3Full title of the trial
    A Phase 2, Multicenter, Clinical Study to Evaluate the Safety and Efficacy of MK-1308A (Coformulated MK-1308/MK-3475) in Combination with
    Lenvatinib (E7080/MK-7902) in First-line Therapy of Participants with Advanced Hepatocellular Carcinoma
    Sperimentazione Clinica di Fase 2, Multicentrica, per verificare la Sicurezza e l’Efficacia di MK1308A (co-formulazione di MK-1308/MK-3475) in combinazione con Lenvatinib (E7080/MK-7902) come Terapia di Prima Linea in pazienti con Carcinoma Epatocellulare Avanzato.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Phase 2 Study of MK 1308A (Coformulated MK 1308/MK-3475), plus Lenvatinib (E7080/MK-7902) in First-line Therapy of Advanced Hepatocellular Carcinoma
    Studio di fase 2 di MK 1308A (MK 1308/MK 3475 coformulato), più Lenvatinib (E7080/MK 7902) nella terapia di prima linea del carcinoma epatocellulare avanzato
    A.3.2Name or abbreviated title of the trial where available
    -
    -
    A.4.1Sponsor's protocol code numberMK-1308A-004
    A.5.4Other Identifiers
    Name:INDNumber:151343
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorMERCK SHARP & DOHME CORP. UNA SUSSIDIARIA DI MERCK & CO. INC.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMSD Italia S.r.l.
    B.5.2Functional name of contact pointDivisione Ricerca Clinica
    B.5.3 Address:
    B.5.3.1Street AddressVia Vitorchiano 151
    B.5.3.2Town/ cityRoma (RM)
    B.5.3.3Post code00189
    B.5.3.4CountryItaly
    B.5.4Telephone number00390636191371
    B.5.5Fax number00390636380371
    B.5.6E-mailgcto.italy@merck.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameMK-1308A (Coformulated MK 1308/MK 3475)
    D.3.2Product code [MK-1308A]
    D.3.4Pharmaceutical form Solution for injection/infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.9.2Current sponsor codeMK-1308
    D.3.9.4EV Substance CodeSUB191936
    D.3.10 Strength
    D.3.10.1Concentration unit µg/ml microgram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1430
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPEMBROLIZUMAB
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475 (Anti–PD-1)
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit µg/ml microgram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number22860
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name KEYTRUDA® (Pembrolizumab, MK-3475)
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V A.I.C. n. EU/1/15/1024/002
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePembrolizumab
    D.3.2Product code [MK-3475]
    D.3.4Pharmaceutical form Solution for injection/infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475 (Anti–PD-1)
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLenvatinib/MK-7902
    D.3.2Product code [E7080]
    D.3.4Pharmaceutical form Capsule
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLenvatinib
    D.3.9.1CAS number 417716-92-8
    D.3.9.2Current sponsor code-
    D.3.9.4EV Substance CodeSUB64419
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number4
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Advanced hepatocellular carcinoma without any prior systemic treatment
    Carcinoma epatocellulare avanzato senza alcun trattamento sistemico precedente
    E.1.1.1Medical condition in easily understood language
    Advanced hepatocellular carcinoma without any prior systemic treatment
    Carcinoma epatocellulare avanzato senza alcun trattamento sistemico precedente
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10073071
    E.1.2Term Hepatocellular carcinoma
    E.1.2System Organ Class 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1. To assess the safety and tolerability of study intervention with MK- 1308A/lenvatinib;
    2. To evaluate the efficacy of MK-1308A/lenvatinib with respect to overall response rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) as assessed by blinded independent central review (BICR);
    1. valutare la sicurezza e la tollerabilità dell'intervento dello studio con MK-1308A/lenvatinib.;
    2.valutare l'efficacia di MK-1308A/lenvatinib rispetto al tasso di risposta complessiva (ORR) in base ai Criteri di valutazione della risposta nei tumori solidi (Response Evaluation Criteria in Solid Tumors, RECIST) 1.1 come valutato mediante revisione centrale indipendente in cieco (blinded independent central review, BICR).
    E.2.2Secondary objectives of the trial
    1. To evaluate the efficacy of MK-1308A/lenvatinib with respect to duration of response (DOR) per RECIST 1.1 as assessed by BICR.
    2. To evaluate the efficacy of MK-1308A/lenvatinib with respect to disease control rate (DCR) per RECIST 1.1 as assessed by BICR.
    3. To evaluate the efficacy of MK-1308A/lenvatinib with respect to progression-free survival (PFS) per RECIST 1.1 as assessed by BICR.
    4. To evaluate the efficacy of MK-1308A/lenvatinib with respect to time to progression (TTP) per RECIST 1.1 as assessed by BICR.
    5. To evaluate the efficacy of MK-1308A/lenvatinib with respect to overall survival (OS).
    6. To evaluate efficacy outcomes of MK-1308A/lenvatinib per modified RECIST (mRECIST) assessed by BICR.
    1. valutare l'efficacia di MK-1308A/lenvatinib rispetto alla durata della risposta (duration of response, DOR) secondo i criteri RECIST 1.1, come valutata mediante BICR.
    2. valutare l'efficacia di MK-1308/lenvatinib rispetto al tasso di controllo della malattia (disease control rate, DCR) secondo i criteri RECIST 1.1, come valutata mediante BICR.
    3. valutare l'efficacia di MK-1308/lenvatinib rispetto alla sopravvivenza libera da progressione (progression-free survival, PFS) secondo i criteri RECIST 1.1, come valutata mediante BICR.
    4. valutare l'efficacia di MK-1308/lenvatinib rispetto al tempo alla progressione (time to progression, TTP) secondo i criteri RECIST 1.1, come valutata mediante BICR.
    5. valutare l'efficacia di MK-1308A/lenvatinib rispetto alla sopravvivenza globale (overall survival, OS).
    6. valutare gli esiti di efficacia di MK-1308A/lenvatinib in base a mRECIST valutati mediante BICR;
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Has an HCC diagnosis confirmed by radiology, histology, or cytology (fibrolamellar and mixed hepatocellular/ cholangiocarcinoma subtypes are not eligible).
    Radiologic confirmation of diagnosis is provided by the study site and confirmed by BICR. Clinically confirmed diagnosis of HCC as per the AASLD criteria, which requires: Radiographically evident cirrhosis o A liver mass that shows arterial phase hyperenhancement on triphasic CT or MRI, AND EITHER:
    - > =20 mm with either nonperipheral portal washout or an enhancing capsule
    - 10-19 mm with nonperipheral portal venous washout AND anenhancing capsule
    2. Has BCLC Stage C disease, or BCLC Stage B disease not amenable to locoregional therapy or refractory to locoregional therapy, and not amenable to a curative treatment approach.
    3. Has a Child-Pugh class A liver score within 7 days prior to first dose of study intervention.
    4. Has a predicted life expectancy of >3 months.
    5. Has at least 1 measurable HCC lesion based on RECIST 1.1, confirmed by BICR.
    6. Has an ECOG PS of 0 to 1 within 7 days prior to first dose of study intervention.
    7. Is at least 18 years of age at the time of providing documented informed consent.
    8. Male participants are eligible to participate if they agree to the following during the intervention period and for at least 7 days after receiving the last dose of lenvatinib:
    - Be abstinent from heterosexual intercourse (abstinent on a long-term and persistent basis) and agree to remain abstinent
    - Use contraception unless confirmed to be azoospermic (vasectomized or secondary to medical cause )
    9. A female participant is eligible to participate if she is not pregnant or breastfeeding, or is not a WOCBP is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), with low user dependency, or be abstinent from heterosexual intercourse (abstinent on a long-term and persistent basis) during the intervention period and for at least 120 days after MK-1308A and 30 days after lenvatinib, whichever occurs last after the last dose of study intervention.
    10. Il partecipante (o un rappresentante legalmente riconosciuto) ha fornito documentato il consenso/assenso informato per lo studio.
    11. Participants with past or ongoing HCV infection will be eligible. The treated participants must have completed their treatment at least 1 month prior to starting study intervention.
    12. Participants with controlled hepatitis B will be eligible as long as:
    - Antiviral therapy for HBV must be given for at least 4 weeks and HBV viral load must be < 500 IU/mL prior to first dose of study drug.
    Participants on active HBV therapy with viral loads <100 IU/mL should stay on the same therapy throughout study intervention.
    - Participants positive for antihepatitis B core antibody HBc, negative for HBsAg, and negative or positive for antihepatitis B surface antibody (HBs), with an HBV viral load under 100 IU/mL, do not require HBV antiviral prophylaxis.
    13. Has adequately controlled BP with or without antihypertensive medications, defined as BP =150/90 mm Hg at Screening and no change in antihypertensive medications within 1 week before Cycle 1 Day 1.
    14. Has adequate organ function defined in the study protocol
    1. Presenta una diagnosi di HCC confermata da radiologia, istologia o citologia (i sottotipi di fibrolamellare e epatocellulare/colangiocarcinoma misto non sono idonei)
    La conferma radiologica della diagnosi viene fornita dal centro dello studio e confermata dal BICR. Diagnosi clinicamente confermata di HCC secondo i criteri AASLD (Appendice 13), che richiede: cirrosi radiograficamente evidente o massa epatica che mostra iper-enhancement della fase arteriosa su TC trifase o RM
    - > =20 mm con washout portale non periferico o capsula di enhancement
    - 10-19 mm con washout venoso portale non periferico E una capsula enhancing
    2. Presenta una malattia BCLC allo stadio C o una malattia BCLC allo stadio B non suscettibile a terapia locoregionale o refrattaria a terapia locoregionale e non suscettibile a un approccio di trattamento curativo.
    3. Ha un punteggio epatico di classe A di Child-Pugh entro 7 giorni prima della prima dose dell'intervento dello studio.
    4.Ha un'aspettativa di vita prevista di >3 mesi.
    5. Ha almeno 1 lesione HCC misurabile in base a RECIST 1.1, confermata da BICR
    6. Ha un ECOG PS da 0 a 1 entro 7 giorni prima della prima dose dell'intervento dello studio.
    7. Ha almeno 18 anni al momento in cui fornisce il consenso informato documentato
    8. I partecipanti di sesso maschile sono idonei alla partecipazione se durante il periodo dell'intervento e per almeno 7 giorni dopo aver ricevuto l'ultima dose di lenvatinib accettano di:
    - Praticare l'astinenza dai rapporti eterosessuali (astinenza continuativa e a lungo termine) e acconsentire a rimanere astinenti
    - Usare la contraccezione a eccezione degli individui con azoospermia confermata (ottenuta tramite vasectomia o secondaria a causa medica [Appendice 5]) come indicato di seguito:
    9. Una partecipante è ritenuta idonea alla partecipazione se non è in gravidanza o in allattamento o non è fertile o è una donna in età fertile e utilizza un metodo contraccettivo altamente efficace (con un tasso di fallimento di <1% all'anno), con una bassa dipendenza dell'utilizzatore o pratica l'astinenza dai rapporti eterosessuali e abituale (astinenza a lungo termine e su base continuativa), come descritto in Appendice 5, durante il periodo di intervento e per almeno 120 giorni dopo MK-1308A e 30 giorni dopo lenvatinib, a seconda di quale si verifica per ultimo dopo l'ultima dose dell'intervento dello studio.
    Una donna in età fertile deve ottenere un risultato negativo da un test di gravidanza altamente sensibile (analisi delle urine o test sierico, come richiesto dalle normative locali) entro 24 ore prima della prima dose dell'intervento dello studio.
    10. The participant (or legally acceptable representative) has provided documented informed consent/assent for the study.
    11. I partecipanti con infezione da HCV passata o in corso saranno eleggibili. I partecipanti trattati devono aver completato il loro trattamento almeno 1 mese prima di iniziare l'intervento dello studio.
    12. I partecipanti con epatite B controllata saranno eleggibili purché:
    - La terapia antivirale per l'HBV deve essere somministrata per almeno 4 settimane e la carica virale dell'HBV deve essere < 500 IU/mL prima della prima dose del farmaco in studio.
    I partecipanti in terapia attiva per l'HBV con carica virale <100 IU/mL devono mantenere la stessa terapia per tutta la durata dello studio.
    - I partecipanti positivi per l'anticorpo antiepatite B core HBc, negativi per l'HBsAg e negativi o positivi per l'anticorpo di superficie dell'epatite B (HBs), con una carica virale dell'HBV inferiore a 100 IU/mL, non richiedono la profilassi antivirale dell'HBV.
    13. Ha una pressione adeguatamente controllata con o senza farmaci antipertensivi, definita come pressione =150/90 mm Hg allo screening e nessun cambiamento nei farmaci antipertensivi entro 1 settimana prima del giorno 1 del ciclo.
    14. Ha una funzione d'organo adeguata definita nel protocollo dello studio.
    E.4Principal exclusion criteria
    1. Has had esophageal or gastric variceal bleeding within the last 6 months. All participants will be screened for esophageal or gastric varices unless such screening has been performed in the past 3 months before first dose of treatment. If varices are present, they should be treated according to institutional standards before starting study intervention; esophageal or gastric varices that require interventional treatment within 28 days prior to first dose of study drug are excluded.
    2. Has bleeding or thrombotic disorders or use of factor X inhibitors or anticoagulants requiring therapeutic INR monitoring, eg, warfarin or similar agents. Treatment with low molecular weight heparin is permitted.
    3. Has clinically apparent ascites on physical examination.
    4. Has inferior vena cava or cardiac involvement of HCC based on imaging, confirmed by BICR.
    5. Has had clinically diagnosed hepatic encephalopathy in the last 6 months unresponsive to therapy. Participants on rifaximin or lactulose
    during Screening to control their hepatic encephalopathy are not allowed.
    6. Has medical contraindications that preclude all forms of contrastenhanced imaging (CT or MRI).
    7. Has gastrointestinal malabsorption, gastrointestinal anastomosis, or any other condition that might affect the absorption of lenvatinib
    8. Has a preexisting Grade =3 gastrointestinal or non-gastrointestinal fistula.
    9. Has clinically significant hemoptysis from any source or tumor bleeding within 2 weeks prior to the first dose of study drug.
    10. Has clinically significant cardiovascular impairment within 12 months of the first dose of study intervention.
    11. Has had major surgery to the liver within 4 weeks prior to the first dose of study intervention.
    12. Has had a minor surgery (ie, simple excision) within 7 days prior to the first dose of study intervention (Cycle 1 Day 1).
    13. Has serious nonhealing wound, ulcer, or bone fracture.
    14. Has received any systemic chemotherapy, including anti-VEGF therapy, or any systemic investigational anticancer agents for treatment of HCC.
    15. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PDL2 agent or with an agent directed to another stimulatory or coinhibitory T-cell receptor (eg, CTLA-4, OX-40, or CD137).
    16. Has received locoregional therapy to liver (transcatheter chemoembolization, transcatheter embolization, hepatic arterial infusion, radiation, radioembolization, or ablation) within 4 weeks prior to the first dose of study intervention.
    17. Has received prior radiotherapy to a nonliver region within 2 weeks of start of study intervention.
    18. Has received a live or live-attenuated vaccine within 30 days before the first dose of study drug.
    19. Is participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study intervention.
    20. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior the first dose of study intervention
    21. Has a additional malignancy that is progressing or has required active treatment within the past 3 years.
    22. Has a known history of CNS metastases and/or carcinomatous meningitis as assessed by local site investigator.
    For more exclusion criteria see the protocol
    1. Negli ultimi 6 mesi ha avuto sanguinamento delle varici esofagee o gastriche. Tutti i partecipanti saranno sottoposti a screening per varici esofagee o gastriche a meno che tale screening sia stato eseguito negli ultimi 3 mesi prima della prima dose del trattamento. Se sono presenti varici, devono essere trattate secondo gli standard istituzionali prima di iniziare l'intervento dello studio; sono escluse le varici esofagee o gastriche che richiedono un trattamento interventistico entro 28 giorni prima della prima dose del farmaco dello studio;
    2. Presenta disturbi emorragici o trombotici o in caso di uso di inibitori del fattore X o anticoagulanti che richiedono un monitoraggio terapeutico dell'INR, ad esempio warfarin o agenti simili. Il trattamento con eparina a basso peso molecolare è consentito.
    3. Presenta ascite clinicamente evidente all'esame obiettivo.
    4. Presenta vena cava inferiore o coinvolgimento cardiaco dell'HCC in base alla diagnostica per immagini, confermato mediante BICR.
    5. Negli ultimi 6 mesi ha avuto diagnosi clinica di encefalopatia epatica non rispondente alla terapia. Non sono consentiti i partecipanti che assumono rifaximina o lattulosio durante lo screening per controllare la loro encefalopatia epatica.
    6. Presenta controindicazioni mediche che impediscono tutte le forme di imaging con contrasto enhanced (TC o RM).
    7. Presenta malassorbimento gastrointestinale, anastomosi gastrointestinale o qualsiasi altra condizione che potrebbe influenzare l'assorbimento di lenvatinib.
    8. Ha una fistola gastrointestinale o non gastrointestinale pre-esistente di grado =3.
    9. Presenta emottisi da qualsiasi origine o sanguinamento da tumore clinicamente significativo nelle 2 settimane precedenti la prima dose del farmaco dello studio.
    10. Presenta una compromissione cardiovascolare clinicamente significativa nei 12 mesi dalla prima dose dell'intervento dello studio.
    11. Ha subito un intervento chirurgico maggiore al fegato nelle 4 settimane precedenti alla prima dose di intervento dello studio.
    12. Ha subito un intervento chirurgico minore (es. semplice escissione) entro 7 giorni prima della prima dose dell'intervento dello studio (Ciclo 1 Giorno 1).
    13. Presenta gravi ferite non cicatrizzanti, ulcera o frattura ossea.
    14. Ha ricevuto qualsiasi chemioterapia sistemica, inclusa la terapia anti-VEGF, o qualsiasi agente antitumorale sperimentale sistemico per il trattamento dell'HCC.
    15. Ha ricevuto una terapia precedente con un agente anti PD-1, anti PD-L1 o anti PD-L2 o con un agente diretto a un altro stimolante o recettore co-inibitorio delle cellule T (ad es. CTLA-4, OX-40 o CD137).
    16. Ha ricevuto una terapia locoregionale al fegato (chemioembolizzazione transcatetere, embolizzazione transcatetere, infusione arteriosa epatica, radioterapia, radioembolizzazione o ablazione) nelle 4 settimane precedenti la prima dose del trattamento dello studio.
    17. Ha ricevuto precedente radioterapia in una regione non epatica nelle 2 settimane prima dell'inizio dell'intervento dello studio.
    18. Ha ricevuto un vaccino vivo o vivo-attenuato entro 30 giorni prima della prima dose del farmaco in studio
    19. Sta partecipando o ha partecipato a uno studio di un agente in fase di sperimentazione o ha usato un dispositivo in fase di sperimentazione entro 4 settimane prima della prima dose dell'intervento di studio.
    20. Ha una diagnosi di immunodeficienza o sta ricevendo una terapia sistemica cronica con steroidi (in dosi superiori a 10 mg al giorno di prednisone equivalente) o qualsiasi altra forma di terapia immunosoppressiva entro 7 giorni prima della prima dose dell'intervento di studio
    21. Ha un ulteriore tumore maligno che sta progredendo o ha richiesto un trattamento attivo negli ultimi 3 anni.
    22. Ha una storia nota di metastasi al sistema nervoso centrale e/o meningite carcinomatosa come valutato dallo sperimentatore del sito locale.
    Per maggiori criteri di esclusione si veda il protocollo
    E.5 End points
    E.5.1Primary end point(s)
    1. Number of participants with a Dose-Limiting Toxicity (DLT) in the Safety Lead-in Phase
    2. Number of participants with >=1 adverse event (AE)
    3. Number of participants with >=1 serious adverse event (SAE)
    4. Number of participants with >=1 immune-related AE (irAE)
    5. Number of participants with >=1 hepatic AEs
    6. Number of participants discontinuing study treatment due to an AE
    7. Overall Response Rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) as assessed by blinded independent central review (BICR)
    1. Numero di partecipanti con tossicità dose-limitante (Dose-limiting tossicity, DLT) solo fase di lead-in di sicurezza.
    2. Numero di partecipanti con >=1 eventi avversi (AE), AE epatici.
    3. Numero di partecipanti con >=1 eventi avversi seri (SAE)
    4.Numero di partecipanti con >=1 AE immuno-correlati (irAE)
    5 .Numero di partecipanti con >=1 AE epatici
    6. Numero di partecipanti che interromponol'intervento dello studio a causa di un AE.
    7. In base ai Criteri di valutazione della risposta nei tumori solidi (Response Evaluation Criteria in Solid Tumors, RECIST) 1.1 come valutato mediante revisione centrale indipendente in cieco (blinded independent central review, (BICR)
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Cycle 1 (Up to approximately 3 weeks)
    2. Up to approximately 26 months
    3. Up to approximately 26 months
    4. Up to approximately 26 months
    5. Up to approximately 26 months
    6. Up to approximately 26 months
    7. Up to approximately 26 months
    1. Ciclo 1 (fino a circa 3 settimane)
    2. Fino a circa 26 mesi
    3. Fino a circa 26 mesi
    4. Fino a circa 26 mesi
    5. Fino a circa 26 mesi
    6. Fino a circa 26 mesi
    7. Fino a circa 26 mesi
    E.5.2Secondary end point(s)
    1. Duration of Response (DOR) per RECIST 1.1 as assessed by BICR
    2. Disease Control Rate (DCR) per RECIST 1.1 as assessed by BICR
    3. Progression Free Survival (PFS) per RECIST 1.1 as assessed by BICR
    4. Time to progression (TTP) per RECIST 1.1 as assessed by BICR
    5. Overall Survival (OS)
    6. ORR per modified RECIST (mRECIST) as assessed by BICR
    7. DOR per mRECIST as assessed by BICR
    8. DCR per mRECIST as assessed by BICR
    9. PFS per mRECIST as assessed by BICR
    10. TTP per mRECIST as assessed by BICR
    1. Durata della risposta (Duration of Response- DOR) per RECIST 1.1 come valutato da BICR
    2. Tasso di controllo della malattia (Disease Control Rate-DCR) per RECIST 1.1 come valutato da BICR
    3. Sopravvivenza libera da progressione (Progression Free Surviva - PFS) per RECIST 1.1 come valutato da BICR
    4. Tempo alla progressione (Time to progression-TTP) per RECIST 1.1 come valutato da BICR
    5. Sopravvivenza globale (Overall Surviva - OS)
    6. ORR per RECIST modificato (mRECIST) come valutato da BICR
    7. DOR per mRECIST valutato da BICR
    8. DCR per mRECIST valutato da BICR
    9. PFS per mRECIST valutata da BICR
    10. TTP per mRECIST valutato da BICR
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to approximately 26 months
    2. Up to approximately 26 months
    3. Up to approximately 26 months
    4. Up to approximately 26 months
    5. Up to approximately 26 months
    6. Up to approximately 26 months
    7. Up to approximately 26 months
    8. Up to approximately 26 months
    9. Up to approximately 26 months
    10. Up to approximately 26 months
    1. Fino a circa 26 mesi
    2. Fino a circa 26 mesi
    3. Fino a circa 26 mesi
    4. Fino a circa 26 mesi
    5. Fino a circa 26 mesi
    6. Fino a circa 26 mesi
    7. Fino a circa 26 mesi
    8. Fino a circa 26 mesi
    9. Fino a circa 26 mesi
    10. Fino a circa 26 mesi
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    Aperto
    Open
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA7
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    China
    Japan
    Korea, Republic of
    Russian Federation
    Taiwan
    Turkey
    Ukraine
    United States
    Italy
    Poland
    Spain
    Switzerland
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS - The overall study ends when the last participant completes the last study-related contact, withdraws consent, or is lost to follow-up (ie, the participant is unable to be contacted by the investigator).
    LVLS - Lo studio complessivo termina quando l'ultimo partecipante completa l'ultimo contatto relativo allo studio, ritira il consenso, o è perso al follow-up (cioè, il partecipante non può essere contattato dallo sperimentatore).
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years5
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years5
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 55
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 55
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state8
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 23
    F.4.2.2In the whole clinical trial 110
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    none
    nessuno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2021-06-09
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-04-08
    P. End of Trial
    P.End of Trial StatusOngoing
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